Minutes. Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 May 27, :00 p.m.

Transcription

1 Minutes Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 May 27, :00 p.m. Present: Terence McMahon, Chairman, District 5 Mark Dewane, Vice Chairman, District 2 Mary A. Harden, R.N., Director, District 1 Susan Gerard, Director, District 3 arrived at 1:10 p.m., left at 3:02 p.m. Elbert Bicknell, Director, District 4 left at 3:02 p.m. Others Present: Steve Purves, MIHS, President & Chief Executive Officer Kathy Benaquista, MIHS, Interim Chief Financial Officer Robert E. Fromm, Jr., M.D., M.P.H., MIHS, Chief Medical Officer Sherry Stotler, R.N., M.S.N., MIHS, Chief Nursing Officer Michael Peck, M.D., MIHS, Chief of Staff Louis B. Gorman, MIHS, District Counsel Guest Presenters: Kelly Summers, MIHS, Chief Information Officer Jean Morris, R.N., MIHS, Director Quality & Care Management Sherrie Beardsley, B.S.N., R.N., MIHS, Magnet Program Manager Gene Cavallo, MIHS, Vice President Behavioral Health Services Michael Grossman, M.D., MIHS, Vice President Academic Affairs Recorded by: Cynthia Cornejo, MIHS, Deputy Clerk of the Board Call to Order Chairman McMahon called the meeting to order at 1:00 p.m. Roll Call Ms. Cornejo called roll. Following roll call, it was noted that four of the five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represents a quorum. Director Gerard arrived during the executive session discussion. Pledge of Allegiance Vice Chairman Dewane led the Pledge of Allegiance. Call to the Public Chairman McMahon called for public comment. There were no comments from the public.

2 Mission Statement Ms. Cornejo read the Mission Statement aloud. General Session, Presentation, Discussion and Action: 1. Motion to Recess General Session and Convene in Executive Session Vice Chairman Dewane moved to recess general session and convene in executive session at 1:01 p.m. Director Harden seconded. Motion passed by voice vote. General Session, Presentation, Discussion and Action: Chairman McMahon reconvened general session at 1:15 p.m. 2. iprotean Online Course iprotean is an online resource for hospital board trustee education, and provides online courses in four categories: governance, finance, quality, and mission/strategic. 3. Approval of Consent Agenda: a. Contracts: i. Approve Amendment #14 to the Professional Medical Services Agreement ( ) with District Medical Group ii. iii. iv. Approve a new Cooperative Purchasing Agreement ( ) with Piper Jaffray & Co. Approve Amendment #3 to the Agreement ( ) between Compass Cooperative Mutual Health Network, LLC and Maricopa County Special Health Care District Approve a six (6) month extension to the lease ( ) with Konica Minolta Inc. b. Medical Staff: i. Approve MIHS Medical Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for May 2015 ii. iii. Approve MIHS Allied Health Professional Staff Appointments, FPPEs, Reappointments, and Resignations for May 2015 Approve Proposed Revisions to the Department of Anesthesiology-Certified Registered Nurse Anesthetist Privileges/Practice Prerogatives v. Approve Affidavits Appointing Kamala Premkumar, M.D., and Robert Klaehn, M.D., as Deputy Medical Directors in the Department of Psychiatry 2

3 3. Approval of Consent Agenda, cont. c. Governance: i. Approve American Insurance Group, Inc. (AIG) property insurance policy for period June 1, 2015 through May 31, 2016 Director Bicknell requested items 3.a.i. and 3.a.iv. be removed from the consent agenda to be discussed and voted on separately. Director Harden requested item 3.b.i. be removed from the consent agenda to be discussed and voted on separately. Chairman McMahon requested item 3.a.ii. be removed from the consent agenda to be discussed and voted on separately. Director Gerard moved to approve the consent agenda minus items 3.a.i., 3.a.ii., 3.a.iv., and 3.b.i. Vice Chairman Dewane seconded. Motion passed by voice vote. Director Bicknell referred to item 3.a.i., amendment #14 to the professional medical services agreement with District Medical Group (DMG), and requested clarification on the net patient revenue. Dr. Fromm explained that the financial implications considered all elements of care, including new patients, estimated revenue per patient visit, and the added cost for practitioners. Director Bicknell referenced the five-year proforma for the Comprehensive Health Center (CHC) and asked if the inflation in expenses included salaries and benefits for physicians or if it was all-inclusive. He also requested clarification on the costs associated with professional fees. Mr. Purves explained the staffing expenses were allocated in two categories; the physicians and mid-level practitioners contracted with DMG were included in professional fees, while nurses and support staff employed by MIHS were factored in the salaries and benefits expense. Director Harden requested a roll call vote. Vice Chairman Dewane moved to approve consent agenda item 3.a.i., amendment #14 to the Professional Medical Services agreement ( ) with District Medical Group. Director Gerard seconded. VOTE: 4 ayes; Director Bicknell, Director Gerard, Vice Chairman Dewane, Chairman McMahon 1 nay; Director Harden Motion passed. Chairman McMahon referred to item 3.a.ii., a new cooperative purchasing agreement with Piper Jaffray & Co., and stated that the costs associated with the agreement was not included in the information received. Mr. Purves stated that there would be no cash flow impact, as the cost associated with the agreement would be deducted from the bond issuance. That cost was not to exceed $50,000. 3

4 3. Approval of Consent Agenda, cont. Director Harden moved to approve consent agenda item 3.a.ii., a new cooperative purchasing agreement ( ) with Piper Jaffray & Co. not to exceed $50,000. Vice Chairman Dewane seconded. Motion passed by voice vote. Director Bicknell addressed item 3.a.iv., a six-month extension to the lease with Konica Minolta, and questioned the reason and timing for the extension. Mr. Purves said the current print and copier services were evaluated and it was determined that another vendor could reduce costs. The extension would allow adequate time to implement the new services and there would not be overlapping of the two contracts. Director Harden moved to approve consent agenda item 3.a.iv., a six (6) month extension to the lease ( ) with Konica Minolta Inc. Vice Chairman Dewane seconded. Motion passed by voice vote. Director Harden referred to item 3.b.i., the Maricopa Integrated Health System (MIHS) medical staff roster, and questioned the delay in submitting resignations to the Board for approval. Dr. Fromm explained that there were various factors in causing that delay. Director Harden moved to approve consent agenda item 3.b.i., the MIHS medical staff appointments, FPPEs, reappointments, change of privilege/status, waiver requests, and resignations for May Vice Chairman Dewane seconded. Motion passed by voice vote. 8. Approve Settlement Agreement and Claim Release between Maricopa County Special Health Care District d/b/a Maricopa Integrated Health System, on behalf of itself and its Individual Insureds and Beazley Insurance Company, Inc. Director Gerard moved to approve the settlement agreement and claim release between Maricopa County Special Health Care District d/b/a Maricopa Integrated Health System, on behalf of itself and its individual insureds and Beazley Insurance Company, Inc. Vice Chairman Dewane seconded. Motion passed by voice vote. 4. Discuss and Review the Maricopa Integrated Health System Quarterly Quality Report Ms. Morris reviewed the vision of quality at MIHS, which included safe care, quality health care, and patient-centric care. Patients expect three things while receiving care; to be kept safe, to be healed, and to be treated with respect. To promote safe care, there was an effort to reduce falls. Staff implemented a Post Fall Huddles program, which reduced falls by half. There was also focus placed on reducing readmissions by forming a transition program that provides improved wrap around services for the patient and helps navigate them through the system with expectations of reducing readmissions. The infection control team produced a monthly newsletter that reiterates the standard precautions to reduce infections. 4

5 4. Discuss and Review the Maricopa Integrated Health System Quarterly Quality Report To focus on quality health care, there was an emphasis on reducing obstetric morbidity by identifying high blood pressure early in the admission for the pregnant patient. She stated that MIHS had a poster presented at the Arizona Association of Women s Health, Obstetric and Neonatal Nurses and the Vital 2015 America s Essential Hospitals conference in June. Ms. Morris stated that America s Essential Hospital awarded the Refugee Clinic with a Gage Award for a Remarkable Project of reducing health disparities. MIHS was also awarded the Midas+ Platinum Quality Award for Excellence in Clinical Quality Outcomes for 2014 as a top performer. Chairman McMahon asked how the qualifications for the Midas award were determined. Ms. Morris said the requirements included the five legacy core measures and MIHS had shown great improvement in those areas. There were approximately 800 hospitals that use Midas nationwide and MIHS ranked in the 95 th percentile, which was a substantial improvement over prior years. Director Gerard asked how the improvements were made. Ms. Morris said there was a concerted effort by physicians and nurses, increased communication, and reminders and educational tools to keep the information at the forefront. There were monthly reports to track the results. Chairman McMahon requested the Midas scores for the previous five years. Dr. Hobohm reiterated the effort placed on education throughout the organization, especially with the medical residents. Mr. Purves commended the work completed by the quality team, including Ms. Morris and Dr. Hobohm. Ms. Beardsley reviewed the new direction for patient experience at MIHS and noted the new relationship with National Research Corporation (NRC). She shared the most current year to date results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and noted that 63.6% of respondents rated MIHS with the top box scores and the results were improving for the fourth quarter. Director Harden requested clarification on the n factor. Ms. Beardsley stated that factor was the number of surveys returned. There was additional focus placed on increasing the return rate for the HCAHPS surveys since there are Centers for Medicare & Medicaid Services (CMS) requirements for the number of surveys needed. Due the specific patient requirements, beginning July 1, all eligible patients will receive the HCAHPS survey. Director Gerard asked if the surveys were available in Spanish. Ms. Beardsley said all surveys were available in English and Spanish. There was also an option to conduct the survey by phone; however, the surveys were mailed to the patient. Vice Chairman Dewane said the surveys were voluminous and somewhat intimidating and asked if MIHS had any control of the content. Ms. Beardsley said MIHS adopted the standard survey and the HCAHPS survey had specific questions required. Currently, the only concern on the return rate was for the HCAHPS surveys. She reviewed the results for the adult clinics and noted the increase in the return rate, which was the year to date figure. Director Harden requested that the number of surveys sent out be included in future reports. 5

6 4. Discuss and Review the Maricopa Integrated Health System Quarterly Quality Report Ms. Beardsley said that patients received a survey for the specific clinic they visited and the questions were targeted for the services they received. She noted that a different vendor, Tonic, was used for behavioral health patients, due to the uniqueness of the service provided. She reviewed the results. Ms. Beardsley highlighted the comprehensive improvement plan in place to address the opportunities identified. All aspects of the patient experience were aligned with the MIHS mission, nursing mission, and the quality framework of MIHS, with all being patient-centric. 5. Semi-Annual Presentation on Maricopa Integrated Health System Nursing and Patient Services Ms. Stotler highlighted the activities surrounding Nurse s Week; there were 12 nominations for recognition in nursing with three individuals recognized for being nurse leaders. She stated that 54.3% of nursing staff throughout MIHS had obtained a Bachelor of Science in Nursing (BSN) or higher degree and 12.5% had received certification in a specialized area. She reviewed the New Grad Program and noted the partnerships and collaborative efforts made with Grand Canyon University and other institutions. There were continued partnerships with various nursing programs to provide student rotations. She reviewed the areas of focus for quality and safety and stated that there were opportunities for improvement in infection control and central line infections. Director Harden referred to the information for central line associated blood stream infections (CLABSI) standardized infection ratio and noted that of the 13 quarters reported, MIHS met or was below the benchmark only twice. She asked how the nursing department was addressing the CLABSI. Ms. Stotler reviewed the action plan to improve CLABSI outcomes, which included ongoing education, alerts within the Epic system, and collaboration with the providers to determine the line placement and proper assessment of line maintenance. Dr. Fromm noted the national average for the standardized infection rate was 1.5; however, MIHS set the internal target rate at 0.5. Ms. Stotler reviewed the results for catheter associated urinary tract infection (CAUTI), which was another area of focus. Director Harden asked if the benchmark used for CAUTI was an internal target or the national average. Dr. Fromm said the national average was 1.0; however, the internal target was adjusted due to the patient population in the burn unit and other intensive care units. He noted the significant improvement made in the past three quarters. Chairman McMahon asked what contributed to the improvement. Ms. Stotler referred to the implemented action plan to improve CAUTI outcomes. She stated that there was also focus on the C. difficile standardized infection ratio. Ms. Morris reviewed the statistics on inpatient falls and noted the substantial decrease in falls in recent months. Ms. Stotler discussed the various projects to transform care the bedside, including a taskforce to prevent alarm fatigue, and the implementation of simulations and mock codes. There was also an effort to transform the care in behavioral health by improving the environment and implementing symptom reduction measures. The registered nurse (RN) coordinators in the patient center medical homes (PCMH) were providing population management and outreach to reduce readmissions. 6

7 Break from 3:02 p.m. to 3:12 p.m. 6. Semi-Annual Report on the Graduate Medical Education Programs as Maricopa Integrated Health System Including the Results of Match Week Dr. Grossman reviewed the history of the National Resident Matching Program and noted the new requirement for participating in the program; all accredited positions for each program must be included and registered in the process. This applied to the primary residency programs, not the fellowship programs. Recently, the supplemental offer and acceptance program (SOAP) was created to place students that did not match during the preliminary match process. He reviewed the national results and expressed some concern regarding the lack of available residency training programs available on a national level. He reviewed the match results for MIHS and stated that there were three vacant positions available after the primary match and SOAP process. Mr. Purves referred to the national results and asked what happened to the students that did not match. Dr. Grossman said the students would be able to reapply for an available position in the next year. The number of medical school graduate was expected to increase in the upcoming years; however, the number of residency programs had not increased much over the past 20 years. Chairman McMahon asked what was being done on a national level to increase the number of residency programs available. Dr. Grossman said that little was being done due to financial resources available. 7. Discuss and Review April 2015 Maricopa Integrated Health System Financial Report and Key Indicator Dashboards Ms. Benaquista reviewed the operational dashboard for April Acute admissions were below budget and there was an increase in behavioral health admissions, due to the addition patient beds in Unit 10. Ambulatory volumes continued to exceed budget and were better than prior year. The surgical center volumes were below budget. The emergency department visits were better than budget, with 14.2% of adult visits resulting in admissions. The ratio of full time employee (FTE) to adjusted occupied bed (AOB) was better than budget, as well as better than prior year. Director Harden referred to the turnover rate, 26.07%, and asked for the contributing factors. Mr. Purves said there were a variety of factors; including many other organizations had increased their recruiting efforts and were enticing qualified personnel with incentives, particularly in the information technology (IT) department. Ms. Benaquista reviewed operational data for the health plans. Chairman McMahon stated the member months for the Maricopa Health Plan (MHP) decreased by 10% for the month of April and asked for an explanation. Ms. Benaquista explained that a member may be retroactively eligible for three months before their member months were reported. When that occurred, the three member months were counted in the current month, increasing the member months for that particular reporting month. She reviewed the activity for the exchange program and provided statistics on Meritus utilization at MIHS, which showed significant growth in the ambulatory setting. Vice Chairman Dewane referred to the financial dashboard and asked what long-term debt was included in the cash to debt figure. 7

8 7. Discuss and Review April 2015 Maricopa Integrated Health System Financial Report and Key Indicator Dashboards, cont. Ms. Benaquista said the amount included in long-term debt was $19 million, and the amount at full maturity was $24 million. She reviewed the remainder of the of financial dashboard and noted the total cash and investments totaled 46 days of cash on hand; however, the medical center had 30 days of cash on hand. There was a change in the FQHC billing methodology, which created an issue with getting claims billed and paid. There was a meeting scheduled with AHCCCS to address the issue. She stated many other community health centers had encountered similar challenges. Director Harden asked when the issue occurred. Ms. Benaquista stated the change in the billing methodology began April 1. Chairman McMahon asked if there was an expected resolution date. Ms. Benaquista said she expected a resolution within a week. She referred to the financial report and noted the addition of the narrative on key components affecting the financial activity for the month. Director Harden referred to the statement of revenue for the service lines and requested an explanation for the variance in supply costs for Home Assist Health (HAH). Ms. Benaquista explained that when the budget for HAH was created, there were four high-level items since there was no history to predict expenses. Moving forward, the budget would account for the various expense categories. Chairman McMahon referred to the consolidated statement of revenues and expenses and noted the substantial increase in total deductions. Ms. Benaquista said there was a lot of movement between charity care and bad debt and the focus was placed on net patient revenue. Chairman McMahon stated that there was also a significant variance in net patient revenue, $27 million on a year to date basis. Ms. Benaquista said many assumptions were considered when the budget was created, such as the decrease in self-pay patients. However, the number of self-pay patients had not decrease as expected. Many factors contributed to the negative variance; the bad debt was a major contributor. She explained that there was an aggressive effort made to locate a payer source for uninsured patients. The patient account was classified as bad debt within 30 days and the information was given to an agency charged with collecting payment. Any payment recovered from the agency was deducted from the bad debt reported. Mr. Purves said that safety net hospitals across the country were facing the same challenges with the implementation of the Affordable Care Act (ACA); they were not experiencing the benefits of those converting to commercial insurance. Combined with the reduction of rates through Medicare and Medicaid, many safety net hospitals were operating with substantial budget variances. Chairman McMahon referred to the Maricopa Medical Center statement of revenue, expenses, and noted the change in net assets was negative $32 million. The operations dashboard reported that 14% of the emergency room department visit resulted in admission. He asked how much of the variance was a result of the emergency room department admissions. Ms. Benaquista said the number could be quantified and would look into it. Chairman McMahon said in order to address the issue of bad debt, there needed to be an understanding of where it was coming from. 8

9 9. Concluding Items a. Old Business: March 11, 2015 Formal Meeting Bond Issuance When the time is appropriate, please provide the Board with a list of needs/proposal of projects along with accompanying Board resolution to issue bonds. March 25, 2015 Uncompensated Care In the next days, present the Board with Financial Assistance Policy, Structure, Philosophy and Implementation b. Board Member Requests for Future Agenda Items or Reports c. Comments i. Chairman and Member Closing Comment a. Committee Reports b. Summary of Educational Sessions ii. President & Chief Executive Officer Summary of Current Events Chairman McMahon reviewed the old business. He stated that there would be a document presented for the financial assistance policy in June. Dr. Fromm said that there would be a recommendation from the Maricopa Health Centers Governing Council regarding the Sliding Fee Discount Program for the FQHCs. An overall philosophical discussion and management of uncompensated care required input from the Board. Ms. Benaquista said that there were preliminary discussions and a review of current policies and procedures; however, those discussions were interrupted with the development of the fiscal year 2016 budget. She suggested the discussion take place in July. Director Harden reiterated her request to receive a detailed line item budget to review prior to considering the fiscal year 2016 budget for approval. Vice Chairman Dewane requested a high-level operations report from Home Assist Health. Mr. Purves stated the Arizona Hospital and Health Association convened the Medicaid Taskforce today, the goal was to develop principle policy recommendation for consideration. He commended the staff for the effort placed on improving operating margins and the progress of the revenue cycle initiatives. Adjourn Director Harden moved to adjourn the May 27, 2015 Special Health Care District Board of Directors Finance/Quality Meeting. Vice Chairman Dewane seconded. Motion passed by voice vote. 9

10 Meeting adjourned at 4:23 p.m. Terence M. McMahon, Chairman Special Health Care District Board of Directors 10